Health and medical care in China

Take out travel insurance with high cover, drink bottled water and carry your medication in its original packaging. Everything else can be sorted out: Chinese hospitals are good and cheap, and there is a pharmacy on every corner.

Before you leave

Travel clinic. Ideally six weeks ahead, to leave time for vaccines that need two doses. Recommended: hepatitis A, typhoid, tetanus and diphtheria up to date, and for long stays or rural areas, Japanese encephalitis and rabies. Anyone arriving from a country with yellow fever risk — as is the case on some routes from Brazil — must present an international vaccination certificate.

Travel insurance. Not optional. A stay in an international clinic in Beijing easily costs 5,000 to 20,000 dollars, and a medical evacuation home costs more than the whole trip. We always require proof of insurance with minimum cover of 100,000 dollars and repatriation assistance.

Medication. Bring it in the original box, with the prescription translated into English. Some drugs that are common in Europe — certain opioid painkillers, some psychoactive drugs, and decongestants containing pseudoephedrine in quantity — are restricted; check with the embassy before travelling and bring only what you need for the length of the stay.

Water, food and sun

Tap water is not potable. Hotels provide flasks of boiled water, which is the local custom and perfectly safe to drink. Outside the hotel, bottled water — two bottles a day per person, a negligible cost.

Rules that prevent almost every upset stomach:

• Eat where the locals eat. A queue at the door is the best indicator of freshness.
• Prefer what is cooked to order. Wok, steamer, grilled skewers.
• Avoid raw food on hot days. Salads, fruit hand-peeled at street stalls.
• Fruit you peel yourself is safe: banana, tangerine, mango.
• Wash your hands before meals; carry sanitiser gel for road days.

Sun and heat. Summer in the south is humid and heavy: 35 degrees at 80% humidity. A hat, water and a rest at midday resolve most cases of clients feeling unwell in July and August. It is worth adding rehydration salts to the kit: they are sold in any Chinese pharmacy and rescue a ruined afternoon in two hours.

Toilets

This is the subject we are asked about most, and it deserves to be addressed plainly. Public toilets have improved enormously, but paper and soap are still missing at monuments, stations and roadside stops. We always carry a pocket kit: tissues, wet wipes and gel.

There are squat toilets everywhere, and Western-style toilets in hotels, airports, shopping centres and newer trains. On our itineraries we plan stops at hotels and shopping centres, not roadside toilets.

Hospitals and pharmacies

In the big cities there are international hospitals and private clinics with English-speaking doctors, in Beijing, Shanghai, Guangzhou and Chengdu. They are expensive — that is what the insurance is for — but they avoid queues and operate to Western standards.

Pharmacies are plentiful and sell many antibiotics and anti-inflammatories over the counter. For simple things — a sore throat, diarrhoea, a food allergy — a trip to the pharmacy resolves it in ten minutes, and the guide handles the translation. They are identified by a green sign with a cross at the door, and on the streets of the big cities there is one every two or three doors.

Traditional Chinese medicine can be an interesting experience: acupuncture and Tui Na massage are safe and inexpensive, provided it is at recognised establishments that we recommend.

Altitude and exertion

In Lhasa (3,650 m), Shangri-La (3,200 m) and the Sichuan corridor, the body needs time. Common symptoms in the first 48 hours: headache, breathlessness climbing stairs, irregular sleep. The rules are to arrive gradually, sleep a night at medium altitude first, drink two litres of water a day, avoid alcohol on arrival and take it easy on the first day.

On the groups we escort we carry a pulse oximeter and portable oxygen, and guides are trained to recognise the signs of altitude sickness and descend immediately if warranted.

Heat, cold and pollution: three concrete scenarios

What clients report to us is rarely serious illness; it is badly managed discomfort. Three scenarios are worth more than generic advice:

Humid summer heat, in the south and east. 35 degrees with high humidity, and the body cannot cool down. Water, salts and shade at midday. We plan mornings for the street and two in the afternoon for museums, hotels and restaurants; nobody wants to climb the Xianggong viewpoint at 2pm in full sun.

Dry cold of the north. In Harbin, at minus 20, the risk is staying out too long out of enthusiasm. Two hours at a time, returning somewhere warm, and watch fingers and ears. Keep phone batteries close to your body.

Pollution and pollen. There have been years of consistent improvement, but high PM2.5 days still occur in the northern winter, and March and April bring pollen and sandstorms. Anyone with asthma travels with rescue medication and follows the day’s index; we suggest a KN95 mask on those days and on crowded trains during flu season.

In all three cases the rule is the same: tell the guide before it gets worse. A day’s programme can be rearranged; a night in hospital cannot.

If you fall ill mid-tour

It happens: a dental problem, diarrhoea, an allergic reaction, a twisted ankle on a step of the Great Wall. The procedure is simple because it happens to us often.

Tell the guide. He or she speaks English, judges whether it is a pharmacy, clinic or hospital matter, and shortens the day without asking for explanations. The itinerary is private, so recovering a morning does not mean losing sights: we reorganise the order and pick up what was missed over the following days. On days when there is nothing to be done, you stay at the hotel and go to an appointment; we handle the booking, the payment and, when needed, contact with the insurer for prior authorisation.

All we ask in return is the policy number and the assistance line at first contact, so we do not lose a morning looking for them later.

Contacts

110 police · 119 fire · 120 ambulance · your embassy in Beijing and the consulates in Shanghai and Macau. Our clients receive a laminated card with these numbers, their insurance details and a permanent office contact in English. Keep it in your wallet, not in the suitcase: it is meant to be used, not filed.